NEWS
China prioritises HIV eradication

FRIDAY, JUNE 17, 2005

GEJIU, China The small storefront looks like just another shop in this city. But inside, health workers offer testing for HIV and dispense methadone to drug users. Upstairs, a group offers counseling and support for anyone with HIV or AIDS.

Not far away, another group has opened a drop-in center for parents of drug users to exchange information about how to prevent HIV. In another office, the city's prostitutes, numbering more than 1,000, can find free condoms, HIV testing and advice on keeping the virus at bay.

Here in the mountainous southwestern province of Yunnan, where heroin begat AIDS and AIDS begat death, discrimination and official denial, Gejiu is emerging as a model of how the country is now trying to reverse its once abysmal record on AIDS. In the past 18 months, China's top leaders have made AIDS a national priority and introduced a host of new policies.

Not too long ago China denied it had an AIDS problem and tried to cover up a blood-selling program that had infected untold thousands of farmers. Even now, the police in some cities still arrest and harass AIDS activists or try to conceal the presence of the disease.

But places like Gejiu are starting to carry out the central government's new policies, including offering needle exchanges and making condoms available in hotel rooms. And the Health Ministry is planning for growth: China now has eight methadone clinics but is considering expanding that to 5,000 by 2010.

"There are still many countries where this is against the law," said Peter Piot, executive director of Unaids, speaking of the needle exchanges and the methadone program.

The remaining problems are myriad and daunting. The rural public health system is in near collapse and few health workers are properly trained in treating HIV or AIDS. Only one person in nine knows he or she has the virus. A free antiretroviral drug program hurriedly introduced by the government has had serious problems, with roughly one patient in five dropping out.

But international experts agree that the country's new response far surpasses that of India and Russia, the other regional giants with even more severe AIDS problems.

And the newfound political will from Beijing has impressed many skeptics.

"It's clear that the senior leadership at the national level and the leadership in this province are taking this problem very seriously," said Randall Tobias, who heads the Bush administration's AIDS program, during a joint visit with Piot.

The turning point, Piot said, came in 2003, when the rapid and unexpected spread of SARS showed the government that communicable diseases could pose not just a health threat but also a political one.

"Nothing did as much as the fear that SARS instilled in terms of the potential for destabilizing society," Piot said.

The shift in attitude was signaled in December 2003 when Prime Minister Wen Jiabao met with AIDS patients, a step later repeated by President Hu Jintao. These symbolic steps have been accompanied by a doubling of the government's budget for AIDS and several new policies, like needle exchanges and condom promotion. Until 2002, condom advertising was banned.

Experts here and abroad have predicted that more than 10 million Chinese could be infected with HIV by 2010 if the government does not rapidly increase its efforts. The government estimated in 2003 that 840,000 people were HIV-positive, while an additional 80,000 had AIDS. About 150,000 more people with AIDS are believed to have died.

Heroin flows into Yunnan Province from neighboring Vietnam, Laos and Myanmar.

With a population of 44 million, Yunnan has only 200 health workers trained to treat the disease. Officials estimate that the province has 80,000 infected people, mostly intravenous drug users who have spread the disease by sharing needles.

In Gejiu, a city of 310,000 people on a route favored by drug traffickers, initial rounds of AIDS testing found more than 1,000 people with HIV, nearly all of them drug users or prostitutes.

Tong Waiyuan, a vice mayor, explained that Yunnan's new plan included needle exchanges, condom promotion, and more testing, education and counseling.

"The whole society is involved," said Tong, wearing an AIDS pin as he briefed Piot and Tobias.

Piot and Tobias spent three days in Yunnan to highlight cooperation between the United States and the United Nations on AIDS. They chose Gejiu because a handful of the projects were being financed with international money, including some from the United States.

Unlike some other provinces, Yunnan has welcomed outside help. Britain, Australia and the United States are among those providing assistance.

Nearly all of the projects in Gejiu are less than a year old and just beginning to jell into a prevention and treatment network, and huge challenges remain.

At the methadone clinic, financed in part with U.S. money, Ming Xiangdong said that more than 270 drug users had come for help since it opened in April 2004. Demand is so high that a second, larger clinic opened in early June. But government regulations say that only drug users who have dropped out of official detoxification centers can qualify for the methadone program.

At the Gejiu Women's Center, which also receives American support, prostitutes receive education and training in HIV prevention and the use of condoms, as well as counseling on changing professions.

"I know lots of women with HIV," said a woman at the center, who wore a white lace dress with a cellphone dangling from a long green necklace. "All of them are still working."

She said that the center's workers were trying to get infected prostitutes out of the sex business or at least get them to use condoms. But prostitution is often the highest-paying work available. Just as health officials are starting to reach out to prostitutes and drug users, officials in Yunnan have been cracking down. AIDS workers worry that a recent provincewide sweep of drug users will drive HIV-infected people underground and increase, rather than reduce, the broader public health risk.

In other provinces, the situation is often far worse. A new report by Human Rights Watch found that AIDS activists were still harassed by local officials. Web sites that disseminate AIDS information to gay people have been shut down.

In one widely reported incident, the police burst into a treatment center in a southern city and arrested drug users meeting with health workers.

"For AIDS control in Yunnan Province, we have a long, hard journey and have to overcome many contradictions," said Chen Juemin, director of the provincial health bureau. "We have some results and achievements. But it is just a first step."

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